Failed extubation after cardiac surgery in young children: Prevalence, pathogenesis, and risk factors*

Harrison, A. Marc; Cox, Amy; Davis, Steve; Piedmonte, Marion; Drummond-Webb, Jonathan J.; Mee, Roger B.B.

doi:10.1097/00130478-200204000-00011

Cited by 115 publications

(130 citation statements)

References 15 publications

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“…For example, upper airway obstruction leading to extubation failure has been implicated in 2-4% of patients in studies focused on children recovering from cardiac surgery. [6][7][8] Interestingly, one of these studies, 4 of 7 patients who failed extubation did so in the operating room secondary to extrathoracic upper airway obstruction, 8 indicating, as also demonstrated in our report, that patients need not be endotracheally intubated for prolonged periods of time to experience post-extubation stridor. In two studies of patients requiring tracheostomy following cardiac surgery, extrathoracic upper airway obstruction followed by tracheostomy placement occurred in 0.2% and 0.5% of patients.…”

Section: Discussionsupporting

confidence: 77%

“…Upper airway obstruction has also been implicated as important contributor to extubation failure, which has been associated with increased morbidity and mortality in this patient population. [6][7][8] In the most severe cases, tracheostomy is required to facilitate long-term recovery. [9][10][11] Current literature cites wide-ranging incidences of upper airway obstruction in the non-cardiac pediatric ICU population from 5-40%.…”

Section: Introductionmentioning

confidence: 99%

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Prevalence and Risk Factors for Upper Airway Obstruction after Pediatric Cardiac Surgery

Green

Walters

Delius

et al. 2015

The Journal of Pediatrics

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Objective: To determine the incidence of and risk factors for extrathoracic upper airway obstruction after pediatric cardiac surgery.Study Design: A retrospective chart review was performed on 213 patients less than 18 years of age who recovered from cardiac surgery in our multidisciplinary intensive care unit in 2012.Clinically significant upper airway obstruction was defined before performing the chart review as post-extubation stridor with at least one of the following: greater than two corticosteroid doses, receiving helium-oxygen therapy, or re-intubation. Multivariate logistic regression analysis was performed to determine independent risk factors for this complication.Results: Thirty-five patients (16%) with extrathoracic upper airway obstruction were identified.On bivariate analysis, patients with upper airway obstruction had greater surgical complexity, higher vasoactive medication requirements, and longer postoperative durations of endotracheal intubation. They were also more difficult to calm while on mechanical ventilation, as indicated by higher narcotic infusion doses and greater likelihood to receive dexmedetomidine or vecuronium. On multivariable analysis, adjunctive use of dexmedetomedine or vecuronium (odds ratio: 4.4, 95% confidence intervals: 1.8-10.5) remained independently associated with upper airway obstruction. Conclusion:Extrathoracic upper airway obstruction is relatively common following pediatric cardiac surgery, especially in children who are difficult to calm while endotracheally intubated.Postoperative upper airway obstruction could represent an important outcome measure in future studies of optimal sedation practices in this patient population.2

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Section: Discussionsupporting

confidence: 77%

Section: Introductionmentioning

confidence: 99%

Prevalence and Risk Factors for Upper Airway Obstruction after Pediatric Cardiac Surgery

Green

Walters

Delius

et al. 2015

The Journal of Pediatrics

View full text Add to dashboard Cite

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“…Study of the Neirotti et al (15) showed, as well as our research, that failure to thrive is one of the risk factor of prolonged ventilation [95%CI (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)]. …”

supporting

confidence: 72%

“…From all evaluated postoperative factors, significant influence had lung diseases, with odds ratio 35 times and blood transfusion (Odds 4 time), which also emphasize Szekely (20).…”

mentioning

confidence: 74%

“…Early extubation was defined as mechanical ventilation in period shorter than 24 hours (practically shorter than 24 hours, usually 4-8 hours) (1)(2)(3)(4). Determination of the optimal moment for extubation is based on clinically and laboratory factors, that indicates possibility of appropriate blood gas exchange during spontaneously breathing.…”

Section: Introductionmentioning

confidence: 99%

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Early extubation after congenital heart surgery

Halimic¹,

Dinarevic²,

Begić³

et al. 2014

JHSCI

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Airway Pathologic Abnormalities in Symptomatic Children With Congenital Cardiac and Vascular Disease

Guillemaud¹,

El‐Hakim²,

Richards³

et al. 2007

Arch Otolaryngol Head Neck Surg

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Objective: To identify the epidemiological profile of airway abnormalities in symptomatic children with cardiac or vascular anomalies.Design: Retrospective medical chart review.Setting: Tertiary referral pediatric hospital.Patients: Children with airway-related symptoms and coexistent cardiac or vascular abnormality were included. The source for patient identification was a prospectively kept database.Main Outcome Measures: Endoscopic airway diagnoses, presenting airway symptoms, cardiac diagnoses, other comorbid conditions and pertinent diagnoses, patient demographics, source of referral, treatments, and follow-up. Results:The study population comprised 77 patients (45 male and 32 female; mean age, 18.2 months) treated between June 2002 and July 2006. Only 4 patients had no findings. The most common airway abnormality was laryngeal paralysis (n=32), followed by subglottic stenosis (n=18). Congenital and acquired lesions were equally encountered (n=70 and n=64, respectively). The most frequent presentation was intolerance to feed (n=51) (stridor and/or failure of extubation). Of the 77 patients, 32 (42%) required airway surgical intervention (open vs closed); 36 (47%) still require otolaryngologic followup; and 32 (42%) had a named syndrome or general multisystem condition.Conclusions: At least 3% of all children with cardiac disease will harbor airway problems. Laryngeal paralysis was the most common problem encountered. Given the successes achievable in treating children with complex cardiac abnormalities, attention should be paid to concomitant and consequential airway problems. Counseling processes should acknowledge the role of early otolaryngologic involvement.

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Failed extubation after cardiac surgery in young children: Prevalence, pathogenesis, and risk factors*

Cited by 115 publications

References 15 publications

Prevalence and Risk Factors for Upper Airway Obstruction after Pediatric Cardiac Surgery

Prevalence and Risk Factors for Upper Airway Obstruction after Pediatric Cardiac Surgery

Early extubation after congenital heart surgery

Airway Pathologic Abnormalities in Symptomatic Children With Congenital Cardiac and Vascular Disease

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